Ask Emily: Getting Lost In Obamacare's Mazes

By: Emily Bazar

To the people who run Covered California, the Medi-Cal program and health insurance companies:

I know what a massive, confusing experiment Obamacare is. I know you’re creating new rules, building new computer systems, hiring new staff members and enrolling hundreds of thousands of Californians in health coverage, all under a very tight – if not unrealistic – deadline.

So I understand that problems and glitches are inevitable. It wouldn’t be fair to expect the rollout to go perfectly.

But does it have to be this difficult?

Case in point: Holly Larkey of San Clemente, who signed up and paid for a new Kaiser plan through Covered California, the state’s health insurance exchange, and did so well before deadline. Then she says she discovered that Covered California or Kaiser – or both – botched her coverage.

Instead of filling her prescriptions and visiting her doctor this month, as she had planned, Holly has been trapped in a Kafkaesque game of bureaucratic ping-pong, in which she is the ball.

If my inbox is any indication, her experience isn’t isolated. Many of you are struggling with bureaucratic fiascos related to your new plans, and not just with Kaiser.

In today’s column, I’m going to give you tips on what to do if you, like Holly, can’t get the coverage you signed up for and paid for.

Q: Can you help me?

A: That’s how Holly, 62, ended her initial email to me.  

Back in November, Holly was thrilled to learn that she qualified for tax credits and would save hundreds of dollars a month on her new Kaiser health plan.

But upon trying to fill one of her prescriptions this month, she learned that Covered California inadvertently canceled her new plan and enrolled her in another one with less coverage. The plan also costs more because her tax credits weren’t applied.

And even though Kaiser cashed the check she wrote for her January premium, she received another bill saying she owes for both January and February.

Holly has doggedly tried to fix the problem and estimates that she has invested at least 50 hours so far. When she calls Covered California – or rather, when she gets through its jammed phone lines – she is told to call Kaiser. Kaiser tells her to call Covered California. She has been assigned two different case numbers, which has muddled the process.

I contacted Covered California to explain Holly’s case and ask what people in her situation should do.

“Covered California recognizes there are people in this situation, and we’re making it a top priority to straighten out these accounts,” says spokeswoman Anne Gonzales.

Gonzales advises people with problems to call the service center at 800-300-1506. I told Gonzales that Holly is doing just that, but often can’t get through or is put on hold for hours.

Gonzales acknowledges that Covered California’s 1,288 phone lines are typically at capacity at any given time.

“We ask that consumers be patient, keep trying,” and – this is important – know that once their cases are resolved, they will get retroactive coverage as long as they’ve met all the enrollment and payment deadlines, she says.

I’m not sure how you can keep up with payment deadlines if you’re not getting billed for the correct plan or the correct amount, but …

Kaiser, too, says the best thing to do is call its main toll-free line: 800-464-4000. (I presume other insurers would instruct you to do the same thing if you’re having trouble with them.)

Like Covered California, Kaiser also is getting deluged with calls, says spokeswoman Sandra Hernandez-Millett. The best times to call are after 5 p.m. or on weekends, she advises.

“Kaiser Permanente will ensure that all members seeking medical care, including new members, are able to receive the care they need when they need it,” she says.

It’s all so simple.

In reality, it’s often not, so I consulted with Anthony Wright, executive director of Health Access California.

Wright reminded me that California has two regulatory bodies that oversee health plans: The Department of Insurance and the Department of Managed Health Care (whose help center can be reached at 888-466-2219).

You should contact them if you aren’t getting the care or coverage you think you’re entitled to under your policy, he says.

But what if you’re having trouble like Holly and aren’t getting enough help from Covered California or your insurer to iron out bureaucratic glitches?

Wright mentioned a resource I referred to in my last column, and it’s one that bears repeating. The Health Consumer Alliance (healthconsumer.org) offers programs across the state that can assist you.

“They will be an advocate for you in this process,” Wright says.

As for Holly, Kaiser contacted her after I inquired about her situation and said her case has been resolved. Covered California, too, says the issue has been resolved.

At the time of my deadline, Holly says she has yet to see proof. Meantime, she thinks back longingly to the days when she thought she had signed up.

“We were in the car one day after I paid my January payment and there was a blurb on the radio indicating that people were having problems signing up online and not getting through. I turned to my husband and said, ‘I am one of the fortunate ones’,” she recalls.

“How ironic.”

 Questions for Emily: [email protected]